VERDICT WATCH UK - Nurse Lucy Letby, Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #29

[ColourPurple]

If I’m being honest, I never quite believed the prosecutions version of the multi tpn bag poisoning. It always seemed quite unbelievable to me and a bit of a stretch to believe. However what’s important is the babies WERE poisoned by synthetic insulin. That part is indisputable and what’s most important.

Like the judge mentioned, the jury aren’t detectives and their job isn’t to act like one. We might never know how they came to be given the insulin, (whether it was the tpn bags or not) but they WERE without a doubt given it by someone.

I just hope there isn’t members of the jury who doubt or question the prosecutions version of the bag poisoning and therefore think they must find her not guilty based on that.

If guilty, the fact that she allegedly injected more than one bag with Baby L makes it possible IMO that she had the foresight to do the same with TPN bags for Baby F. Plus there was only Baby F using TPN bags so she could be reasonably certain that any other TPN bags she poisoned would go to him (and if guilty and just wanting to implicate somebody on another shift probably wouldn't care if they went to another baby anyway). And it's not like there were 30 or 40 other bags stored in the fridge, so injecting a few extra bags, or just a couple at the front with the soonest use by dates, doesn't seem that far fetched... BUT I still think it's more likely that the bag wasn't changed.

JMO , if guilty.

 

[Sweeper2000]

Baby F's was a bespoke TPN bag that had to be used within 48 hours. There was no replacement bespoke bag ready at the time the line was changed so they would have had to either use a generic stock bag instead or carried on using the same bespoke bag. Although it was protocol to change the bag there's no record of a new bag being signed for or hung, and there was no replacement bespoke bag available anyway, so although they could and should have changed the bag, it suggests to me that the bag wasn't changed... but annoyingly we'll never know.

JMO

wou it then explain why if the bag was changed it wasn’t on the prescription chart? No bespoke serial number on the ”generic“ bag used as a replacement for the bespoke one?

 

[ColourPurple]

wou it then explain why if the bag was changed it wasn’t on the prescription chart? No bespoke serial number on the ”generic“ bag used as a replacement for the bespoke one?

I assume they'd still need to sign for it even if a generic stock bag, but @marynnu would know more.

 

[WaxLyrical]

I assume they'd still need to sign for it even if a generic stock bag, but @marynnu would know more.

I think there needs to be a prescription for the stock bag, so the absence of one is significant.

 

[Observe_dont_Absorb]

Baby F's was a bespoke TPN bag that had to be used within 48 hours. There was no replacement bespoke bag ready at the time the line was changed so they would have had to either use a generic stock bag instead or carried on using the same bespoke bag. Although it was protocol to change the bag there's no record of a new bag being signed for or hung, and there was no replacement bespoke bag available anyway, so although they could and should have changed the bag, it suggests to me that the bag wasn't changed... but annoyingly we'll never know.

JMO

But weren't we told from the off that every single bag for neonates was bespoke and created to individual prescription by the pharmacy? That being the very basis of the argument there could have never been any form of mix up.

If bags weren't changed, weren't followed to prescription, or other 'leftover' bags or bags in the fridge for some reason were used or switched out for any baby it hadn't been prescribed for ... this is hugely problematic IMO and absolutely shameful behaviour on behalf of the hospital too.

Were that to be the case though, why would Myers not have grabbed this issue?

 

[Sweeper2000]

I would like to have a gauge on the importance of swapping the bags over. I can see how someone could slip it so to speak but I can also see someone not putting the serial number down. Presumably the same nurse who would put a new one up would be the same one to write the number down?

 

[ColourPurple]

But weren't we told from the off that every single bag for neonates was bespoke and created to individual prescription by the pharmacy? That being the very basis of the argument there could have never been any form of mix up.

If bags weren't changed, weren't followed to prescription, or other 'leftover' bags or bags in the fridge for some reason were used or switched out for any baby it hadn't been prescribed for ... this is hugely problematic IMO and absolutely shameful behaviour on behalf of the hospital too.

Were that to be the case though, why would Myers not have grabbed this issue?

No, not all the bags were bespoke. Baby F's' bag was bespoke but there were also stocks bags in the fridge. My understanding was that most babies (who were using TPN) would just use a standard stock bag unless they specifically needed a bespoke bag. Again @marynnu would have more info re that.

 

[esther43]

I think there needs to be a prescription for the stock bag, so the absence of one is significant.

Not sure they need a prescription. Recall them reporting that the bulk standard bags are simply replenished when supplies run low in the unit fridge. It's an inventory thing I thought.

 

[Observe_dont_Absorb]

No, not all the bags were bespoke. Baby F's' bag was bespoke but there were also stocks bags in the fridge. My understanding was that most babies (who were using TPN) would just use a standard stock bag unless they specifically needed a bespoke bag. Again @marynnu would have more info re that.

Oh no, I feel totally baffled now. I had based my entire opinion on this issue on the mistaken idea that all TPN bags were bespoke and on prescription all the time, that none were 'sitting around' going spare or being stored and none could have been arbitrarily tampered with except after allocation and during /after being hung for use to the individual baby (unless the pharmacy were up to no good which was ruled out as statistically impossible).

Uhhh well that's a room for doubt.

 

[DianaWW]

Oh no, I feel totally baffled now. I had based my entire opinion on this issue on the mistaken idea that all TPN bags were bespoke and on prescription all the time, that none were 'sitting around' going spare or being stored and none could have been arbitrarily tampered with except after allocation and during /after being hung for use to the individual baby (unless the pharmacy were up to no good which was ruled out as statistically impossible).

Uhhh well that's a room for doubt.

Doubt as to how it was done maybe, but there's no doubt that insulin was administered, and that it started when the first bag was hung. It is also true that baby F was the only baby receiving TPN at the time.

They have been told they don't need to concern themselves with how things happened. But at the same time, I do understand them wanting to be clear on what they think happened, I think that's natural. Oh to be a fly on the wall....JMO.

 

[ColourPurple]

Re Baby f's TPN bag. It was reported that the doctor requested that the TPN bag be moved to a peripheral line while they changed the long line around 11am.. maybe I'm misninterpeting that but why would they move it instead of discarding it completely, unless they were planning to carry on using it? The next bespoke bag for Baby F wasn't delivered until 4pm.

Here's what was reported about the TPN bag.

______

Early on August 4, Child E had died. Later that day, the pharmacy received a prescription for a TPN bag for Child F, the twin brother.

A confirmation document was printed, at 12.32pm, for Child F. The pharmacist produced a handwritten correction to say it was to be used within 48 hours of 11.30pm that day.

The TPN bag was delivered up to the ward at 4pm that day.

On that nght shift, the designated nurse for Child F, in room 2, was not Letby.

Letby had a single baby to look after that night, also in room 2.

There were seven babies in the unit that night, with five nurses working.

Letby and the designated nurse signed the prescription chart to record the TPN bag was started and administered via a long line at 12.25am.

A TPN chart is a written record for putting up the bags, and was used for Child F. It includes 'lipids' - nutrients for babies not being given milk.

Letby signed for the TPN bag to be used for 48 hours.

There are two further prescriptions for TPN bags, to run for 48 hours.

Following the conclusion of a Letby night-shift, after the administration of a TPN bag Letby had co-signed for, a doctor instructed the nursing staff to stop the TPN via the longline and provide dextrose (sugar to counteract the fall in blood sugar), and move the TPN to a peripheral line while a new long line was put in.

All fluids were interrupted at 11am while a new long line was put in.

Child F's blood glucose increased, before falling back. A new bespoke TPN was made for Child F, delivered at 4pm.

The prosecution say this could not have been the same one fitted to Child F at noon that day which would have been either a bespoke bag which Lucy Letby co-signed for, or a stock bag from the fridge.

Mr Johnson said Child F's low blood sugar continued in the absence of Lucy Letby.

Child F's blood sample at 5.56pm had a glucose level was very low, and after he was taken off the TPN and replaced with dextrose, his blood glucose levels returned to normal by 7.30pm. He had no further episodes of hypoglycaemia.

"These episodes were sufficiently concerning" that medical staff checked Child F's blood plasma level. The 5.56pm sample recorded a "very high insulin measurement of 4,657".

Child F's hormone level of C-peptide was very low - less than 169.

The combination of the two levels, the prosecution say, means someone must have "been given or taken synthetic insulin" - "the only conclusion".

"That, we say, means that somebody gave Child F synthetic insulin - somebody poisoned him."

"All experienced medical and nursing members of staff would know the dangers of introducing insulin into any individual whose glucose values were within the normal range and would know that extreme hypoglycaemia, over a prolonged period of time, carries life threatening risks.

"No other baby on the neonatal unit was prescribed insulin at the time."

Medical experts Dr Dewi Evans and Dr Sandie Bohin said the hormone levels were consistent with insulin being put into the TPN bag prior to Child F's hypoglycaemic episode.

"You know who was in the room, and you know who hung up the bag," Mr Johnson told the jury.

Professor Peter Hindmarsh said the insulin "had to have gone in through the TPN bag" as the the hypoglycaemia "persisted for such a long time" despite five injections of 10% dextrose.

Professor Hindmarsh said the following possibilities happened.

That the same bag was transferred over the line, that the replacement stock bag was contaminated, or that some part of the 'giving set' was contaminated by insulin fron the first TPN bag which had bound to the plastic, and therefore continued to flow through the hardware even after a non-contaminated bag was attached.

"There can be no doubt that somebody contaminated that original bag with insulin.

"Because of that...the problem continued through the day."

Letby was interviewed by police in July 2018 about that night shift.

She remembered Child F, but had no recollection of the incident and "had not been involved in his care".

She was asked about the TPN bags chart. She said the TPN was kept in a locked fridge and the insulin was kept in that same fridge.

She confirmed her signature on the TPN form.

She had no recollection of having had involvement with administering the TPN bag contents to Child F, but confirmed giving Child F glucose injections and taken observations.

She also confirmed signing for a lipid syringe at 12.10am, the shift before. The prosecution say she should have had someone to co-sign for it.

"She accepted that the signature tended to suggest she had administered it."

"Interestingly, at the end of this part of the interview she asked whether the police had access to the TPN bag that she had connected," Mr Johnson added.

Recap: Prosecution opens trial of Lucy Letby accused of Countess of Chester Hospital baby murders

THE trial of former Countess of Chester Hospital nurse Lucy Letby, who is accused of multiple baby murders, is due to finalise its jury and hear…

www.leaderlive.co.uk

 

[Kemug]

None of those babies died.

It's accepted that it was introduced insulin and that it didnt get there accidentally but that's about all.

True, the babies didn't die, but they were intentionally harmed by somebody. And there is a 50% chance that it was LL.

 

[mummyshark]

No, not all the bags were bespoke. Baby F's' bag was bespoke but there were also stocks bags in the fridge. My understanding was that most babies (who were using TPN) would just use a standard stock bag unless they specifically needed a bespoke bag. Again @marynnu would have more info re that.

My understanding is that the stock bags are there for when babies are first born and taken to NNU, as you wouldn't know at that stage what the individual babies requirements are. So I imagine a newly born baby is given a stock bag until their individual nutritional needs are assessed and a prescription is written for bespoke TPN. I suspect the stock bags have minimal ingredients (fluids and electrolytes).

 

[ColourPurple]

Oh no, I feel totally baffled now. I had based my entire opinion on this issue on the mistaken idea that all TPN bags were bespoke and on prescription all the time, that none were 'sitting around' going spare or being stored and none could have been arbitrarily tampered with except after allocation and during /after being hung for use to the individual baby (unless the pharmacy were up to no good which was ruled out as statistically impossible).

Uhhh well that's a room for doubt.

But the initial TPN definitely was a bespoke bag, delivered at 4pm, signed for and hung by LL and a colleague at 12.25am. The blood sugar problems started when that bag was hung. The question is whether that bag was ever changed at 11am when a new long line was put it, as the blood sugar problems continued until TPN was stopped completely. It was reported that the bag was moved to a peripheral line while they put in the new long line. The nurse can't remember but said that they would've changed the bag... but there is no record of a new bag being hung.

 

[Sweeper2000]

Do you know what I can’t remember the Events surrounding that 11 am line change and I’m wondering if it was a bit frantic or classed as an emergency? Just trying to hedge bets on either of the two mistakes. No bag change against protocol or no documentation for the bag change against protocol.

 

[ColourPurple]

Do you know what I can’t remember the Events surrounding that 11 am line change and I’m wondering if it was a bit frantic or classed as an emergency? Just trying to hedge bets on either of the two mistakes. No bag change against protocol or no documentation for the bag change against protocol.

The line had tissued and they thought this might be causing the low blood sugar. Here are some more updates:
---------------

The shift handover is carried out at 7.30am, with day shift nurse Shelley Tomlins recording a blood glucose level for Child F as 1.7 for 8am.

Prosecutor Mr Johnson says this is a "dangerously low level".

The subsequent reading, recorded at 11.46am, is 1.4.

Dr Ogden records a blood glucose level at 10am for Child F as '1.3'.

Prior to this reading, Letby has been messaging the night-shift designated nurse for Child F, saying: "Did you hear what [Child F]'s sugar was at 8[am]?"

The nurse replies: "No?"

Letby: "1.8"

The nurse replies: "[S***]!!!!", adding she felt "awful" for her care of Child F that night.

Letby: "Something isn't right if he is dropping like that," adding that Child F's heel has to be taken into consideration [as blood gas tests are taken via heel pricks, and cannot be done too regularly].

The nurse responds: "Exactly, he had so much handling. No something not right. Heart rate and sugars."

Letby: "Dr Gibbs came so hopefully they will get him sorted.

"He is a worry [though]."

The nurse replies: "Hpe so. He is a worry."

Letby responds: "Hope you sleep well...let me know how [Child F] is tonight please."

The nurse replies: "I will hun".

Child F's blood glucose level is recorded by a doctor as 2.4 at 12pm.

Further medication administrations are made throughout the morning.

A new long line is also inserted at this time.

Child F's blood glucose level is recorded as being 2.4 at noon, 1.9 at 2pm and 1.3 at 3.01pm.
More dextrose is administered. The blood glucose level is still "very low", the court hears, at 1.9 at 4pm.

Child F's blood glucose level is recorded as being 1.3 at 5.56pm.

A blood test is recorded for insulin to the Royal Liverpool Hospital at 5.56pm. The court hears those results did not come back for a week.

Child F's blood glucose level is recorded as 1.9 at 6pm.

A nursing note records there was a change from the TPN/lipid and 10% dextrose administration to 'just 15% dextrose with sodium chloride added'.

The new fluids were commenced at 7pm.

The designated nurse for the previous night shift returns to care for Child F on the night shift for August 5-6.

She messages Letby to say: "He is a bit more stable, heart rate 160-170."

The long line had "tissued" and Child F's thigh was "swollen".

It was thought the tissued long line "may be" the cause of the hypoglycemia.

The colleague added: "Changed long line but sugars still 1.9 all afternoon. Seems like long line tissued was not cause of sugar problem, doing various tests [to find the source of the problem].

Letby responds: "Oh dear, thanks for letting me know"

The nurse colleague replies: "He is def better though. Looks well. Handles fine."

Letby replies: "Good."

At 9.17pm, Child F's blood glucose level is recorded as being 4.1.

Letby later adds, at 11.58pm: "Wonder if he has an endocrine problem then. Hope they can get to bottom of it.

"On way home from salsa feel better now I have been out."

The colleague replies: "Good, glad you feel better. Maybe re endocrine. Maybe just prematurity."

Letby replies: "How are parents?"

Colleague: "OK. Tired. They've just gone to bed."

Letby: "Glad they feel able to leave him."

Colleague: "Yes. they know we'll get them so good they trust us."

Letby: "Yes.

"Hope you have a good night."

Recap: Lucy Letby trial, Tuesday, November 22

The trial of Lucy Letby, who denies murdering seven babies at the Countess of Chester Hospital neonatal unit and attempting to murder 10 more,…

www.chesterstandard.co.uk

 

[Becky53]

Do you know what I can’t remember the Events surrounding that 11 am line change and I’m wondering if it was a bit frantic or classed as an emergency? Just trying to hedge bets on either of the two mistakes. No bag change against protocol or no documentation for the bag change against protocol.

The long line had tissued, LL couldn’t of predicted this happening - could be a common occurrence though.
I still think the bespoke was re hung hence why there is no documentation for a new one.
jmo

 

[Sweeper2000]

Now I remember. yeh I can see what everyone is getting at. To me it rests on how strict people were with protocol in this instance but I also understand emphasis on why would they reuse the bag? Because it was bespoke and none else were to hand.

so when it comes to bespoke bags ? I’m wondering why none else were available etd

 

[Marantz4250b]

But the initial TPN definitely was a bespoke bag, delivered at 4pm, signed for and hung by LL and a colleague at 12.25am. The blood sugar problems started when that bag was hung. The question is whether that bag was ever changed at 11am when a new long line was put it, as the blood sugar problems continued until TPN was stopped completely. It was reported that the bag was moved to a peripheral line while they put in the new long line. The nurse can't remember but said that they would've changed the bag... but there is no record of a new bag being hung.

This is a window of almost eight and a half hours. How can it be stated with any certainty that only LL and one other nurse had access to it? Surely there would have been possibly dozens of people who had access?

 

[JosieJo]

Regarding the TPN just to say ..even the stock bags have a serial number that must be documented not just bespoke ones